Viewpoints: Soaring Cost Of Drugs; Baltimore’s Health Legacy; ‘Quackery’ Act; Issues For ACOs

The New York Times: Runaway Drug Prices
A drug to treat abnormal heart rhythms can cost about $200 on one day and more than $1,300 the next. A diagnosis of multiple sclerosis can lead to a drug bill of at least $50,000 a year. How companies set prices of specialty drugs for these and other complex diseases, like cancer and AIDS, has been a mystery to the patients who need them. Now the Obama administration and some states are tackling that lack of transparency and the rising costs. Mr. Obama has asked Congress to let Medicare officials negotiate prices with drug manufacturers .... And several states are considering bills that would require drug companies to justify their prices to public agencies. (5/5)

The New York Times: Race, Class And Neglect
Many people have pointed out that there are a number of black neighborhoods in Baltimore where life expectancy compares unfavorably with impoverished Third World nations. But what’s really striking on a national basis is the way class disparities in death rates have been soaring even among whites. Most notably, mortality among white women has increased sharply since the 1990s, with the rise surely concentrated among the poor and poorly educated; life expectancy among less educated whites has been falling at rates reminiscent of the collapse of life expectancy in post-Communist Russia. (Paul Krugman, 5/4)

NPR: Triage And Treatment: Untold Health Stories From Baltimore's Unrest
Over the last week, Baltimore's unrest has captured the nation's attention. Images of burning cars, the sounds of angry protesters and then peace rallies have dominated the airwaves and headlines. As the city's health commissioner, I heard other stories. I spoke with a 62-year-old woman who had a heart attack a year ago and who had stopped taking her blood pressure and blood-thinning medications. Her pharmacy was one of the dozen that burned down, and neither she nor the other people in her senior housing building could figure out where to get their prescriptions filled. ... In the wake of fires and violence, the initial priority for health officials was to make sure that our acute care hospitals were protected and that staff and patients could get to them safely. In the immediate aftermath, our focus was on ensuring that injured patients got triaged and treated. (Leana Wen, 5/4)

The Wall Street Journal: Americans’ Health Priorities Diverge From Washington’s Focus On Obamacare
Given the never-ending debate about the Affordable Care Act, you might think that when Americans are asked to name their top health priorities for the president and Congress, they would pick something related to Obamacare, whether it involves expanding the law, scaling it back, or repealing it. But it turns out the American people don’t live in the ACA bubble. Their top priority overwhelmingly, and on a bipartisan basis, was “making sure high cost drugs for chronic conditions were affordable for people who need them.” (Drew Altman, 5/4)

Modern Healthcare: Beware A 21st Century Quackery Act
Proposed legislation “modernizing” the Food and Drug Administration's approach to approving breakthrough drugs and devices would undermine the agency's ability to protect the American public from unproven and possibly unsafe new products. The so-called 21st Century Cures Act also contains sections that would hamstring healthcare providers and insurers in their efforts to lower the cost of care. Unless the legislation is sharply revised, it should be rejected by Congress or, if need be, vetoed by the president. (Merrill Goozner, 5/2)

The Washington Post's Wonkblog: A Horrifying Reminder Of What Life Without Vaccines Was Really Like
“The patient is placed on the sliding bed, shoved into the cabinet and the shield tightly locked. A rubber collar, which fits so snugly that almost no air can pass, is adjusted about the patient's neck. A switch is turned, and the cabinet begins its work.” This is how a 1930 article in “Popular Mechanics” described an “an artificial lung on wheels.” Better known as a tank respirator or iron lung, the machine ... was once a cutting-edge and living saving treatment for victims of polio. And it is a chilling reminder of what life without vaccines looks like -- and why we should worry about efforts to prevent kids from getting the shots they protect them, and other children, from diseases like measles. (Ana Swanson, 5/4)

The Washington Post: Bad News For Older Folks: Millennials Are Having Fewer Babies
A report released last week by the Urban Institute found that millennial women are reproducing at the slowest pace of any generation in U.S. history. Childbearing fell steeply in the years immediately following the “Great Recession,” with birthrates among women in their 20s declining more than 15 percent between 2007 and 2012. This shouldn’t be surprising. Previous periods of financial turmoil have encouraged women to, at the very least, delay childbearing. (Catherine Rampell, 5/4)

MinnPost: Why Alternative Therapies Are Not Harm-Free
I recently had a conversation with friends about the role of the placebo effect in alternative medical "therapies" such as acupuncture, Reiki and homeopathy. My friends readily acknowledged that such therapies have no basis in science, but they did believe they had a role to play in modern medicine — precisely because of the placebo effect. After all, said my friends, if you feel better after, say, undergoing acupuncture or a Reiki session or after taking a homeopathy cold “remedy,” who cares if it’s only the placebo effect at work? (Susan Perry, 5/4)

The Philadelphia Inquirer: Why I Told My Family My End-Of-Life Treatment Wishes At 28
Two months ago, I filled out a living will. I also signed a health care power of attorney, which appointed a health care agent. One month ago, I emailed the documents to my family and my doctors. Today, I’m still a healthy 28-year old but with an advance health care directive posted on my refrigerator. My advance directive specifies health care instructions if illness or incapacity prevents me from communicating. Composed of two parts, my living will provides guidelines for treatment based on my wishes, while my health care power of attorney authorizes my chosen health care agent to make sure they are followed. Yet, despite the availability of these legal mechanisms to protect your ability to control end-of-life care, I’m joined by only about one-third of Americans in having them. (Krystyna Dereszowska, 5/4)

JAMA: Pioneer Accountable Care Organizations: Traversing Rough Country
In theory, ACOs should be attractive to physicians. They provide an opportunity to proactively improve care for patients. They are an alternative to other methods of controlling costs, such as cuts in payment rates and extensive use of prior authorization. But for ACOs to be broadly successful, they will need stronger incentives, closer ongoing connections with patients, better logistical support from Medicare, and regulatory relief. For ACO programs to grow and be sustainable, physicians and hospitals must believe that they will be at least as well off financially if they become a high-functioning ACO as they would be if they continued with business as usual. ... Funds to reward successful systems will come from lower rates of payment increases over time for physicians and hospitals not in ACOs and from lower payments to low-performing ACOs. (Lawrence P. Casalino, 5/4)

JAMA: Accountable Care Organizations And Evidence-Based Payment Reform
Almost all health insurers have begun to implement ACOs and other accountable care reforms. In principle, this means that the clinicians in the ACOs may be more directly aligned with the goals of better quality and lower cost. However, in most ACOs today, including the Medicare ACOs, the clinicians’ payment is still largely based on FFS [fee for service]. A more “advanced” ACO might shift more of its payments from FFS toward accountable care through caps or reductions in some FFS rates and payments instead coming in the form of a per-member per-month amount that is tied to quality measures for the patient population. This provides more net revenues to the health care organization if costs are lower and quality is maintained, and gives its clinicians more flexibility to change how they deliver care. However, it also places the ACO at greater financial risk. (Mark McClellan, 5/4)

JAMA Internal Medicine: The Veiled Economics Of Employee Cost Sharing
Cost sharing has certainly increased, from copayments for physician office visits and prescription drugs to deductibles; the fraction of workers in a plan with at least a $1,000 deductible for coverage of a single person increased from 10% in 2006 to 41% in 2014. Higher cost sharing feels like a decrease both in the generosity of coverage and in compensation. It seems particularly unfair to lower-wage workers who face the same deductibles and copayments as their higher-paid counterparts and who may be discouraged from seeking needed care. But increase in cost sharing are not necessarily regressive nor necessarily associated with lower compensation. (Katherine Baicker and Amitabh Chandra, 5/4)